Dr. Jeremy Brubaker

We are no longer in the age where the doctor knows best, is a family friend and never questioned. So the question is, what type of business are we in and how do we function in it.  Be honest, most of us are not naturally business minded, we are more mission minded and health conscience.  That’s why you’re in chiropractic school and why we become chiropractors.  As you are well aware, most chiropractic colleges cannot give us the business education we need, and honestly they shouldn’t.  They are not business colleges, they are chiropractic colleges.  It would be like going to your cardiologist for an atlas adjustment, it just doesn’t make sense.  First off, as chiropractic students and doctors we are inundated with management and consulting companies trying to give us business help.  What I’m going to say next may shock you, especially those of you who knew me in school.  I say thank goodness and thank God for some of them that help us become successful.  Now be careful who you deal with, just like anything in life, but don’t rule out all of the folks out there to help you based on a couple knuckle heads.

We’ve been blessed to have a great experience when it comes to getting help in practice and we were taught by one of my mentors the essence of the business we are in.

To quote Dr. Tom Owen, he told me “You’re in the People Business Buddy”.  That has always stuck with me and has kept me grounded even when the success came.  If you plan to be in the chiropractic business long term, you must realize that the management and structure of your practice are vital to success. But without remaining focused on why you are there, and who you are there for, you’ll struggle even if you’re bringing home a decent living.  That may sound counter intuitive, but there are way too many burnt out frustrated chiropractors out there that have profitable practices.  Knowing that as you begin your career may help you avoid that type of situation.  Even if you’re one of those frustrated docs, take some time today and look back at the enthusiasm you had as a fledgling doctor and get it back!

Question: What lights your chiropractic fire?  Protect that flame with your life.

As I was doing some yard work over the weekend it occurred to me what it takes to get a new practice off the ground, and in a hurry.  How does yard work relate to opening an office?  You may ask.

I had just cut some large dried dead grasses, the kind that gets six or seven feet tall.  With them in a large pile down by the creek, I lit one small match and tossed it into the grass without much thought.  Within 20 seconds the grasses were fully engulfed.  It was just then I noticed that the wind was blowing and the Bermuda grass under the pile was extremely dry with plenty of dry leaves and twigs nearby.  You do the math.  Needless to say all conditions were in line for a bunch of flames and neighborhood filling smoke.

Now it took everything to be just right for my small forest fire to spread, but nothing would have happened without the initial spark. That my friends is what it takes to open your successful office with  a bang.  All conditions must be just right to open and open big.  Everything including your clinical system, business system, marketing system and management system must be in place.  But the key to your success is whether or not you have the spark to ignite your fire.  Without it, all the conditions may be right, but you won’t see the growth and success you may expect and desire.

The spark I’m talking about is much more than just your excitement and enthusiasm.  Which by the way are two necessary things.  You must have a passion and love for what you are doing.  That passion comes from knowing what you are doing and why.  So many new graduates truly do not have a clear idea what chiropractic is and the power behind a proper adjustment.   If you take some time and look at some of the ultra successful chiropractors in our profession, that are doing it right, you’ll find a passion and love for chiropractic and for their patients.  They will be able to tell you exactly what they do and why they do it.

Question:  What about Chiropractic lights your fire? Is it strong enough to keep you focused for the next 20-30 years of practice?

Would you like to perform at peak levels of efficiency and productivity with the highest clinical standard possible? If you answered anything but #@%% yes, you should seriously consider why you are putting all your efforts into opening your chiropractic office.

What if I told you that in your practice, you will use very little if any of the protocols and procedures you’ve studied and used in the student or outpatient clinics at your school. Somehow, I bet you’re not surprised at all.  So if you don’t use the protocols you’ve learned in school, what are you going to use?

Are you going to wing it? Shoot from the hip?  Then hope for the best?

With anywhere from one to two hundred thousand of student loans to repay, not to mention thirty to one hundred thousand or more in additional capital invested for start up, are you truly willing to risk all you have invested and your future, just winging it?

This week, take some time and ask yourself, do I currently have a system in place to achieve and exceed my goals for a long term self sustaining practice?

Question:  Are you’re office protocols time tested and proven to deliver outstanding results?

Have you been watching the winter Olympics this year?  I’m from the northeast and my wife is from Minnesota. We’re no strangers to the snow, and love the winter games. What a display of talent and execution!  As I’m watching the technical aspects of each event, I’m in awe how precise the athletes are in all aspects of their sport.  They are true professionals.

Just recently we were on a short ski trip with some friends.  Their two kids had never been on skis, while our son has been on skis every winter since he could stand.  Watching these six and seven year olds struggling to grasp this new concept then negotiate with their muscles to stop and turn on the snow was quite a scene. Our son was zipping around them trying to show them what to do, and it occurred to me how ineffective he was at helping them.

When my wife, a former downhill racer and ski instructor, started guiding them through the basic principles, the light bulbs began to come on.

Now what was the difference?  My wife and son both could ski, but only my wife owns, understands and can communicate the principles needed to ski properly.  As you can guess her approach, with expertise, was much more effective than my six year old saying,  hey watch me.

Why is it that when we come out of school with our chiropractic degree we automatically assuming we are Olympians? Experts in all aspects of opening and running a successful practice.  There’s no doubt that as clinicians we’re prepared to treat patients exiting school.  But come on, we haven’t been training intensely for years to market and manage a business, staff and office procedures?  No wonder the success rate of new Chiropractors is atrocious, and student loan defaults rank among the worst of any profession.  To be the Olympian in your new chiropractic office, you need to train in all aspects of the business.  Operating at peak performance in all aspects of your trade consistently.  That’s the definition of a true professional, and leads to ultra success!

As you start preparing for your new chiropractic practice, take a moment and ask yourself, where do I stand?   Am I seasoned professional, able to execute turns, moguls, jumps and ski through the trees?

More likely there are many aspects of your business that need studied and perfected before heading down the black diamond into your chiropractic practice.

Question:  What are your weak areas, and how do you plan to overcome them?

Imagine with me for just a second, go ahead close your eyes. Well, close them after you read the next sentence. Visualize with me the perfect picture of your new chiropractic office space.  Is it large or small, stand alone or strip, on a busy street or peaceful road?  Every one of you is going to have a different picture in your mind and a myriad of different answers.

Now take a minute and put yourself in patient’s shoes and visualize what you expect, when visiting a doctor’s office for the first time.  Very likely, you will have two very different looking pictures. One important thing when planning your practice is to find a middle ground where you have your own unique space without disappointing a patient’s expectation of what a successful doctor’s office looks like.

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What’s the best business structure for a new Chiropractic Practice?  That depends on the amount of taxes you want to pay.

**Disclaimer time, I’m no CPA or Attorney so blah, blah, blah do your own research**

I’m here to get you to think, not be your CPA.   So let’s keep this simple.

Here are your most common options for business structure:

• Sole Proprietor – All income taxed @ highest rate & self employment tax (earned income)
• LLC,LLP – Layer of personal liability, Flow through and taxed like sole proprietor (earned income)
• C-corp. – Benefits larger companies, more write offs, fringe benefits,   Taxes more complex and dual tax
• S-corp. – Flow through entity, friendly to use but requires organization, but much more tax friendly

I strongly suggest doing your home work.  Here’s a couple places to start:, My New Company, Incorporate Time & Legal Zoom. Now they’ll all try to sell you something, but they give good information and compares strengths and weakness for you.

You never want to evade taxes, that leads to jail.  What you do want to do is minimize your tax liability while using the tax codes the way they were designed, which actually contain many benefits the small business owner.

One of the biggest problems for the new doctors I work with is that they become so successful so fast that their CPAs rarely plan for their income the first year.   Then they get whacked with huge tax bills that they were not prepared for, and nearly go bankrupt while having a hugely successful practice.  I speak from experience, we got slapped with over a 30K tax bill my first year, all my accountant said was “oops, I didn’t expect you to do so well your first year” My intention is not to bash the accountants, we need them, but please be sure to find a wealthy one that utilizes and understands the chiropractic profession as well as corporate structures.  Had I been structured properly, my tax burden would have been 10-15K that first year.  There you go, I may have just saved you close to 20K with this post alone.

Question:  Who do you need on your “power team” to help you set up your business?  Go find them now!

If you need some help on this, I have some great suggestions for you!

I talk with chiropractic students and doctors from all over the country looking to open their offices. Without fail there are always a couple of questions they always asked about how to get their financing:

• What kind of business plan do I need?
• Where do I find financing?

Now, two or three years ago the economic climate was significantly different than today.  So, my recommendations on this subject have evolved and changed accordingly.

What kind of business plan do I need?

It’s simple, a great one. In years past, a good credit score and a logical plan was enough.  Today traditional lenders have changed the rules.  No longer does a good credit score account for much, even a better than average score doesn’t pull the weight it use to.  As a rule, chiropractic students coming out of school are over leveraged and undercapitalized which makes it challenging to get any kind traditional financing.  In order to have a shot with a lender today, you must take your business plan very seriously.  It’s going to take more than the mock one you put together in your stellar business class in Chiropractic College.  One surprising source for small businesses is actually the SBA, there are templates and some great information there for you.  Your business plan must be professional and presented that way, or lenders stop listening very quickly.

Where do I find financing?

The true answer is anywhere you can!  If you picked up the tone from the last question, it’s very difficult to secure traditional financing for a small business start up, let alone a chiropractic practice.  Now is the time to start thinking of other sources for your startup capital.  As students it means minimizing expense increasing savings, part time jobs, conserving those student loans, family contacts, building equity in homes, etc.  If you put together a proper business plan it then becomes much easier to go to non-traditional lenders.  With a thorough plan,  asking friends or family for financing becomes much easier.  Believe it or not, there is still plenty of dollars out there to get your chiropractic office open, it just takes more effort , determination and a don’t quit attitude.

Recently I heard the story of the publishing of Chicken Soup for the Soul.  Jack Canfield went to 35 or so publishers, who said no, but it only took one to say yes, and you know the rest of the story.

Don’t Ever Quit!

Question:  Are you a currently working on your plan to finance your dream?

“If you do what you ought to do when you ought to do it, there will come a time when you can do what you want to do when you want to do it” – Zig Ziggler

B.J. Palmer was quoted as saying something like; Drive until you run out of gas, chop down a tree, build yourself a table and you’ll be successful in practice.  Unfortunately that concept only works if you run out of gas in a good market and have a truck full of power tools.  All too often chiropractic students and doctors starting a new practice use similar demographic research.  The results:  well put it this way, no other health profession comes close to matching the student loan default rate of chiropractic.  Now, don’t be frightened by that statement.   I take that back, you should be very alarmed by that.  Quite honestly, you’re only going to get one shot at opening a successful chiropractic office, so you better do your home work and get some help. Opening an office and starting a new life tends to be a very emotional decision no matter what the demographics show New energetic doctors think, “I can make it anywhere” and “I’m going where I want to go, no matter if its a good market or not”(that’s what I told myself).

Here are 4 principles when deciding where to open a Chiropractic Office:

1. Do your Homework

This goes way beyond just finding out how many Docs are in town and comparing to how many folks live there, although that’s an important thing to know.  I could spend all day talking about this, but I’ve found a great site for demographic research called Locus, its specific for D.C.s and some of your colleges have access already paid for you to use it.  Geography is also important to look at.  If your practice is on the coast, not many folks are coming off ships to see you; thus your drawing area is cut in half.  You really need to get out there and smell these towns to get the feel for them.

2. Take emotion out of the equation

Think of it this way.  Let’s say you’re opening a Subway sub shop and you borrowed 150K and invested in the franchise.  You then found a location for the store and laid down another 80K for build out, opening marketing and other opening expenses.  That’s over 230K invested.  Would you go back to your small hometown (emotional), with 3 subways already there (less than optimal demographics), and expect your friends and family to drive in enough business to compete and succeed with an overabundance of well established competitors?  Of course not.  By the way, who will always be wanting the free food…hum, friends and family.   You will have close to those numbers invested in your profession, and you need to treat it that way.

3. Be careful who you listen to.

What I mean by that is there are a lot of struggling doctors in poor markets looking for chiropractic students to come in as associates to help salvage their practices or pawn their problems off to new doctors looking for a shot in practice.  My intention is not bash all chiropractors that are looking for associates or a buyout, but there is a percentage of docs looking to take advantage of your inexperience.  Like the old saying says, if it seems too good to be true… In those situations take a step back and look closely at the details and the true intentions of the other party.

4. Location, Location, Location.

Isn’t that the mantra of every real estate agent you’ve ever met?  Having the proper market and building are absolutely essential to success.  What most chiropractic students and new docs don’t realize is that the prime real estate on the main drag next to Wal-mart and Walgreens is not necessary for a chiropractic office.  Your rent and property costs are too great, especially when starting up, signage costs are huge in order to compete and stand out with everyone else, and most times it’s a pain to get in and out of the parking lot, which often has limited spots.  When your goal is to help as many people as you can, it’s very frustrating to lose patients because it’s inconvenient for them.

Be Blessed

Question: Is where you want to open your chiropractic practice a good or a great market? Are you Sure?

Where do I start? The all consuming, burning question of all fledgling Chiropractors. Our generation is hoping that apple may have an app for that coming out. After speaking and listening to you, the future of our profession, voice your fears about starting a chiropractic practice, it is horribly apparent that no one is addressing your concerns.

Just go, Google, and try to find good information on starting a chiropractic practice. Aside from a few student forums, several periodic articles and some sites by disgruntled MD’s and DC’s bashing our great profession, there doesn’t seem to be many content rich sites out there for us.

Now there are several companies that put out information such as dynamic chiropractic and Chiro-Economics which often have good content occasionally on this subject, but it’s truly a challenge to find trust worthy materials on a consistent basis.

In the past I’ve stated my love for this profession and how the future of it depends on you! While practicing chiropractic you get to see the true results and the impact the doctor of chiropractic makes to patients lives and their futures, (the exact reason you are in college). If we continue to graduate boat loads of Chiropractors and not equip them for the realities of small business management and productivity, we’ll will continue to see the 82 or so percent of practicing D.C.’s struggle to pay their bills. That my friends, is not making an impact on peoples’ lives or preserving our profession. Helping new doctors succeed what drives me to take the time to give you this blog. Let’s get to some meat and tators.

Here are some of the things I wish someone would have taken time and talk with me about in Chiropractic College. No one did it for me, so let me do it for you.

TOP 10 THINGS I WISH I’D KNOWN IN SCHOOL

10. Where I’m going to practice?
- Is it a good market, (what is a market?)
- Location in market

9. Business Plan
- How am I going to start?
- Plans & Goals for my practice
- How to write an effective business plan

8. Financing
- How to get a bank to loan money
- Why good credit matters
- How to fix my credit while still in school

7. What’s the best business structure?
- LLC, SUB – S, Sole Prop.
- Which is the most tax friendly

6. What do I need to look for actual building?
- Stand alone or strip mall
- Layout, patient flow
- Permits, leases, equipment
- Buy vs. lease

5. How is office going to run
- Office protocol
- Patient flow
- When, where
- Don’t shoot from hip

4. Staff – manage staff
- Need Staff – the most important part of practice
- Great Doctor, poor staff, poor practice
- Hire, fire, pay, motivate
- Referrals to office

3. Marketing – where are patients coming from
- Newspaper, screenings, yellow pages, TV, mailers
- What is effective, getting folks to your office for help

2. Insurance – Taboo, don’t talk a lot about in school
- Know the rules, how to play
- Every state is different
- How to teach someone else how to deal with them
- How to get paid if you want to stay in practice

I don’t want to overwhelm you, but when you get out of school, it’s flat out overwhelming.

…..and the No. 1 thing I wish I’d know when I was sitting in your shoes..

1. There are people out there who want to help you.
- Other docs, mentors, visit/observe them… Read their blogs!
- Professors @ Chiro School: Great resource when in practice as well
- Management groups
i. Good ones, Great ones, and ones to run from
ii. Who’s there to help and who’s there just to make money
(When I was in school I thought they were all out for $)

We are going to explore each of these over the next few posts! Believe it or not from just reading this list you will be further ahead of where I was while sitting in student clinic.

Question: What area are you in need of knowledge, and what do you plan to do about it?